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Ashley Smith acted out to get moved from one jail to another, psychiatrist tells inquiry

Hours after Ashley Smith was admitted to a secure treatment facility in Montreal in April 2007, she needed to be placed in restraints, a coroner’s inquest heard Monday.

Dr. Renée Fugère, a forensic psychiatrist at the Institut Philippe-Pinel de Montréal, where Ashley Smith was admitted in April 2007, told the inquest that Pinel staff were informed about Smith’s maladaptive behaviours. (Donovan Vincent / Toronto Star) | Order this photo

The inquest has heard that Smith was moved 17 times in the 11 months she spent in the federal corrections system between 2006 and 2007. Ashley died of self-asphyxiation in a segregation cell at a women’s prison in Kitchener, Oct. 19 2007.

Her repeated moves have been criticized as harmful to her mental health and an impediment to her developing “therapeutic bonds’’ with clinicians trying to assist her.

Smith ended up at Pinel the early hours of April 13, 2007, after being transferred from the Regional Psychiatric Centre (RPC) in Saskatoon. She was moved out of RPC after becoming unmanageable, and after an investigation was launched when Smith complained that a
correctional supervisor there seriously assaulted her
.

Before RPC, Ashley was at the Nova prison for women in Nova Scotia, where staff, primarily guards, grew weary of always having to attend to her behaviours.

In both instances Smith agreed to the moves.

By May 10, 2007 Ashley was being shipped out of Pinel to another institution. On nearly a daily basis Smith was strapped down or handcuffed at Pinel, due to her continued disruptive or self-harming behaviours, such as tying ligatures around her neck to choke herself, and hiding ligatures in her body cavities, the latter prompting the facility to conduct body cavity searches on her, the inquest heard.

Shortly after arriving at Pinel, Smith was placed in restraints after acting out in her seclusion room. She soon declared that she didn’t like Pinel, and a few days into her stay withdrew her consent to treatment. As a result, Pinel, a secure psychiatric hospital with a separate unit with about a dozen beds for female offenders with mental health difficulties, could only manage Smith, not treat her, the inquest heard.

The unit is operated under contract with Correctional Services of Canada.

By the end of Smith’s stay, Fugère said staff at Pinel and the other patients in the women’s unit were completely “on edge’’ because of Smith’s behaviours, with some of the other women either regressing in their behaviours, or deeply resentful of Smith for all the attention she was getting, the inquest heard.

In the end, Fugère concluded Smith had no insight into her condition — the psychiatrist diagnosed Smith as having an anti-social personality disorder — and given that Ashley refused treatment, it wasn’t possible for Pinel to have an impact on her, the doctor told the inquest in Toronto.

Ashley wasn’t able to take the “risks’’ needed to change her behaviours, Fugère told coroner’s counsel Marg Creal. What Ashley did want however, was control, Fugère said.

“She was miserable at Nova, miserable at RPC, miserable at Pinel . . . . She was miserable everywhere because she was miserable within herself and not able to escape that,’’ Fugère told the inquest.

The doctor does believe that RPC was the place Ashley fared best in, due to its treatment and security component, though the inquest has heard Ashley was beaten there by correctional workers.

Explaining the repeated use of restraints on Ashley while she was at Pinel, Fugère testified that they are used as a “last resort’’ when all interventions fail.

“Restraining is exceptional. It’s not meant to punish or coerce, but help the patient regain control,’’ Fugère testified, adding the decision to use restraints at Pinel must be approved by a physician.

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